mental health and problem gambling
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IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
MENTAL HEALTH AND PROBLEM GAMBLING
Compared to the general population, among those in mental health, drug
and alcohol, family violence, and financial counseling services are between
two and 21 times more likely to also present with problematic gambling
behaviors.2-4
Having experienced clinical anxiety or depression increases the risk of
developing problematic gambling behaviors later on among women. 1
Young adults who are at-risk of and those who
are engaging in problematic gambling
behaviors are at an increased risk of mental
health disorder onset.5
Among adolescents, symptoms of anxiety,
depression, aggression, and antisocial
behavior have been related to being at risk for
developing problematic gambling
behaviors.6*
1. Sundqvist, K. & Rosendahl, I. (2019). Problem gambling and psychiatric comorbidity - risk and temporal sequencing among women and men: Results form the Swelogs case-control study.Journal of Gambling Studies, 35, 757-771.
2. Dowling NA, Cowlishaw S, Jackson AC, et al. (2014a) The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: A systematic review and meta-analysis.Journal of Personality Disorders,1–20.
3. Dowling NA, Jackson AC, Suomi A, et al. (2014b) Problem gambling and family violence: Prevalence and patterns in help-seeking populations. Addictive Behaviors 39: 1713–1717. 4. Jackson AC, Wynne H, Dowling N, et al. (2010) Using the CPGI to determine problem gambling prevalence in Australia: Measurement issues. International Journal of Mental Health and
Addiction 8: 570–582. 5. Afifi, T. O., Nicholson, R., Martins, S. S., Sareen, J. (2016). A longitudinal study of the temporal relation between problem gambling and mental and substance use disorders among young
adults. The Canadian Journal of Psychiatry, 61(2), 102-11. 6. Richard, J., & Derevensky, J. (2017). Identifying the relationship between mental health symptoms, problem behaviors, and gambling among adolescents. Annals of Behavioural Science,
3(2). 7. Dowling, N., Cowlishaw, S., Jackson, A., Merkouris, S., Francis, K., & Christensen, D. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: a
systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(6), 519-539
*For more information regarding youth at risk and mental heal please see the Impacts of Gambling on Youth At Risk brief.
75% of individuals
who seek treatment
for problem gambling
have a psychiatric
comorbidity.7
IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
MAJOR DEPRESSIVE DISORDER
Within a community sample, approximately 32.4% of
individuals who engaged in problematic gambling met the
criteria for major depressive disorder8. Similarly, among
individuals who were seeking treatment for problematic
gambling, 29.9% met the criteria for major depressive
disorder.7
Depressive symptoms have been shown to predict the onset
of gambling behaviors one year later.10
People who engage in problem gambling and have depression are more likely to report
greater severity of problems associated with gambling, history of childhood abuse and
neglect, lower family functioning, and lower levels of extraversion, agreeableness, and
conscientiousness compared to those who engage in problem gambling without
depression.8
BIPOLAR DISORDER
Roughly 8.8% of individuals seeking treatment for
problem gambling also had a bipolar disorder
diagnosis.7
Individuals with a bipolar diagnosis are four times more
likely to have moderate to severe gambling problems
than the general population.11
Individuals meeting criteria for problem gambling and
bipolar disorder reported lower quality of life compared
to those with bipolar who did not engage in problematic
gambling.12
7. Dowling, N., Cowlishaw, S., Jackson, A., Merkouris, S., Francis, K., & Christensen, D. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: asystematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(6), 519-539
8. Quigley, L., Yakovenko, I., Hodgins, D. C., Dobson, K. S., el-Guebaly, D., Casey, D. M., Currie, S. R., Smith, G. J., Williams, R. J., Schopflocher, D. P. (2015). Comorbid problem gambling andmajor depression in a community sample. Journal of Gambling Studies, 31, 1135-1152.
9. Keough, M. T., Penniston, T. L., Vilhena-Churchill, N., Bagby, R. M., & Quilty, L. C. (2018). Depression symptoms and reasons for gambling sequentially mediate the associations betweeninsecure attachment style and problem gambling. Addictive Behaviors, 78, 166-172.
10. Dowling, N. A., Butera, C. A., Merkouris, S. S., Youssef, G. J., Rodda, S. N., Jackson, A. C. (2019). The reciprocal association between problem gambling and mental health symptoms/substance use: cross-lagged path modelling of longitudinal cohort data. Journal of Clinical Medicine, 8, 1888.
11. Jones, L., Metcalf, A., Smith, K. G., Forty, L., Perry, A., Lloyd, J., Geddes, J. R., Goodwin, G. M., Jones, I., Craddock, N., Rogers, R. D. (2015). Gambling problems in bipolar disorder in the UK:prevalence and distribution. The British Journal of Psychiatry, 207, 328-333.
12. Kennedy, S. H., Welsh, B. R., Fulton, K., Soczynska, J. K., McIntyre, R. S., O’Donovan, C., Milev, R., le Melledo, J., Bisserbe, J., Zimmerman, M., Martin, N. (2010). Frequency and correlates ofgambling problems in outpatients with major depressive disorder and bipolar disorder. Canadian Journal of Psychiatry, 55(9), 568-576.
MOOD DISORDERS AND PROBLEM GAMBLING
An estimated 23.1% of individuals seeking treatment for problem gambling also have
mood disorders like major depression and bipolar disorders.7
Approximately 1 in 10
individuals with a
bipolar diagnosis are at
risk of problem
gambling.11
Individuals with more
severe depression
are more likely to
gamble as a way to
cope with unwanted
feelings.9
IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
SUICIDALITY, SELF- HARM AND PROBLEM GAMBLING
Among individuals with problematic gambling behaviors, suicidal behaviors (e.g.,
suicide attempts, completed suicides) are more common among those who also
engage in disordered substance use than those who engage in problem gambling
without disordered substance use.13
Suicidality is 5.3 times higher in individuals with problematic gambling than those
without problematic gambling behaviors.14
Even after controlling for conditions such as depression, substance use, ADHD, and
anxiety, suicidality rates remained 2.9 times higher in those with problematic
gambling than in the general population.14
Although the research is limited, some data suggest a positive relationship - that is,
when one increases so does the other - between non-suicidal self-harm (e.g., cutting,
self-burning, or self-mutilation) and problem gambling.15
PERSONALITY DISORDERS AND PROBLEM GAMBLING
Nearly one half (47.9%) of individuals seeking treatment for problem gambling had
comorbid personality disorders, with the most prevalent being narcissistic (16.6%),
antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline
(13.1%) personality disorders.7
In a large epidemiological study of over 10,000 adults, individuals with problematic
gambling were significantly more likely to be diagnosed with a comorbid personality
disorder (42.96%) than individuals who do not problem gamble (7.3%).16
7. Dowling, N., Cowlishaw, S., Jackson, A., Merkouris, S., Francis, K., & Christensen, D. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: asystematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(6), 519-539
13. Håkansson, A. & Karlsson, A. (2020). Suicide attempts in patients with gabling disorder- associations with comorbidity in cluding substance use disorders. Frontiers in Psychology, 11, 593533.
14. Wardle, H., John, A., Dymond, S., McManus, S. (2020). Problem gambling and suicidality in England: secondary analysis of a representative cross-sectional survey. Public Health,184, 11-16.
15. Gray, H. M., Edson, T. C., Nelson, S. E., Grossman, A. B., & LaPlante, D. A. (2020). Association between gambling and self-harm: a scoping review. Addiction Research & Theory, 1–13.16. Pietrzak, R. H., Morasco, B. J., Blanco, C., Grant, B. F., & Petry, N. M. (2007). Gambling level and psychiatric and medical disorders in older adults: Results from the National
Epidemiologic Survey on alcohol and related conditions. American Journal of Geriatric Psychiatry, 15(4), 301–313.
IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
GENERALIZED ANXIETY DISORDER Approximately 14.4% of individuals seeking treatment for problem
gambling also have a generalized anxiety disorder.7
Generalized anxiety has been shown to predict problem gambling 1 year
later.10
POST-TRAUMATIC STRESS DISORDER A recent review found that across studies, PTSD symptom severity heavily
contributed to gambling disorder severity.17
Approximately 12.3% of individuals who sought treatment for problem
gambling met the criteria for post-traumatic stress disorder.7
People who engage in problematic gambling with a history of PTSD are
more likely to use gambling to cope with unwanted emotions.18
OTHER ANXIETY-RELATED DISORDERS Roughly 13.7% of individuals who sought
treatment for problem gambling also had a
diagnosis of panic disorder.7
14.9% of individuals who sought treatment
for problematic gambling also had a social
phobia.7
An estimated 8.2% of individuals seeking
treatment for problematic levels of
gambling also have obsessive-compulsive
disorder.7
1. Sundqvist, K. & Rosendahl, I. (2019). Problem gambling and psychiatric comorbidity - risk and temporal sequencing among women and men: Results form the Swelogs case-control study. Journal of Gambling Studies, 35, 757-771.
7. Dowling, N., Cowlishaw, S., Jackson, A., Merkouris, S., Francis, K., & Christensen, D. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: a systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(6), 519-539
10. Dowling, N. A., Butera, C. A., Merkouris, S. S., Youssef, G. J., Rodda, S. N., Jackson, A. C. (2019). The reciprocal association between problem gambling and mental health symptoms/substance use:cross-lagged path modelling of longitudinal cohort data. Journal of Clinical Medicine, 8, 1888.
17. Moore III, L. H., & Grubbs, J. B. (2021). Gambling disorder and comorbid PTSD: a systematic review of empirical research. Addictive Behaviors, 114.
18. Ledgerwood, D. M., & Milosevic, A. (2015). Clinical and personality characteristics associated with post traumatic stress disorder in problem and pathological gamblers recruited from the community. Journal of
Gambling Studies, 31, 501-5012.
ANXIETY DISORDERS AND PROBLEM GAMBLING An estimated 17.7% of individuals seeking treatment for problem gambling have an
anxiety disorder.7 Of those engaged in problematic gambling, individuals are twice as
likely to experience any anxiety condition (i.e., PTSD, panic disorder, phobia, generalized
anxiety) than the general population.1
Women who experienced
any anxiety condition
before gambling onset,
tripled their risk of
developing problematic
gambling behaviors.1
IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
AND PROBLEM GAMBLING
One in five individuals with problem gambling having clinical levels of ADHD symptoms. 19
Individuals who engage in problem gambling are 4.18 times more likely to have ADHD
than those who do not engage in problem gambling. Individuals with ADHD were 2.85
times more likely to experience problem gambling than individuals without ADHD.19
18.46% of individuals who engage in problem gambling
also have ADHD and 11.75% of individuals with ADHD also
engage in problem gambling.19
Among males with ADHD, impulsivity traits (1) lack of
premeditation and (2) sensation seeking are not significant
risk factors for problem gambling.20
OTHER HARMFUL BEHAVIORS AND
PROBLEM G AMBLING Problem gambling is significantly related to intimate
personal violence (IPV), with one-third of individuals
with problem gambling reporting being a survivor of
IPV or perpetrators of IPV.3
Individuals who engage in problem gambling are
more likely to lose control of their anger and engage
in aggressive behaviors than individuals who do not
problem gamble.21
There is an increased risk for lying, cheating, and
stealing with those who engage in problem
gambling compared to those who do not.22
3. Dowling NA, Jackson AC, Suomi A, et al. (2014b) Problem gambling and family violence: Prevalence and patterns in help-seeking populations. Addictive Behaviors 39: 1713–1717. 19. Theule, J., Hurl, K. E., Cheung, K., Ward, M., Henrikson, B. (2019). Exploring the relationships between problem gambling and ADHD: a meta-analysis. Journal of Attention Disorders,
23(12), 1427-1437. 20. Brunault, P., Mathieu, S., Faussat, C., Barrault, S., Varescon, I. (2020). Impulsivity facets and cognitive distortions associated with problem gambling: differences between ADHD and
non- ADHD gamblers. Europeans Review of Applied Psychology, 70(4), 100559 21. Aymamí, N., Granero, R., Penelo, E., Fernández-Aranda, F., Krug, I., Gunnard, K., Santamaría, J. J., Bueno, B., Jaurrieta, N., Gómez-Peña, M., Álvarez-Moya, E., Claes, L., Fagundo, A. B.,
Menchón, J. M., & Jiménez-Murcia, S. (2014). Anger in pathological gambling: clinical, psychopathological, and personality correlates. The Spanish Journal of Psychology, 17. https://doi.org/10.1017/sjp.2014.40
22. Lind, K., & Kääriäinen, J. (2018). Cheating and stealing to finance gambling: analysis of screening data from a problem gambling self-help program. Journal of Gambling Issues, 39. https://doi.org/10.4309/jgi.2018.39.9
23. Wong, G., Zane, N., Saw, A., & Chan, A. K. K. (2013). Examining gender differences for gambling engagement and gambling problems among emerging adults. Journal of GamblingStudies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming, 29(2), 171–189. https://doi.org/10.1007/s10899- 012-9305-1
Individuals who engage in
problem gambling tend to
also engage in more
harmful risk taking and
impulsive behaviors
compared to the general
population23.
Emotion
dysregulation in
people with ADHD
contr20ibutes to problem
gambling20
IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
PROBLEM GAMBLING PREVENTION AND INTERVENTION
STRATEGIES
Given the harmful relationship problem gambling has with mental health, prevention strategies
and methods to intervene are important for community stakeholders to know about.
Learn more about the harmful relationship between mental health and problematic
gambling, including prevention, treatment, and ways to support individuals who are
seeking help.
The sequence of comorbidity onset for mental health symptoms and problematic gambling
differ between sexes. Females tend to begin gambling after the onset of depression, anxiety,
and/or substance use problems; conversely, males tend to initiate gambling behaviors prior
to mental health symptom onset.1
Integrate the harmful impact of problem gambling into education opportunities when
discussing mental health concerns and/or developing partnerships.
Use a brief assessment measure
to identify gambling problems
such as the Brief Biosocial
Gambling Screen (BBGS) and
assess functionality in areas of
life (e.g., occupational, financial,
social, interpersonal, and
intrapersonal).24,25
Develop a harm minimization
strategy. Take a responsible
gambling approach and
collaboratively plan what best
aligns with their goals, while also
promoting health and reducing
harm.24
1. Sundqvist, K. & Rosendahl, I. (2019). Problem gambling and psychiatric comorbidity - risk and temporal sequencing among women and men: Results form the Swelogs case-control study. Journal of Gambling Studies, 35, 757-771.
12. Kennedy, S. H., Welsh, B. R., Fulton, K., Soczynska, J. K., McIntyre, R. S., O’Donovan, C., Milev, R., le Melledo, J., Bisserbe, J., Zimmerman, M., Martin, N. (2010). Frequency and correlates of gambling problemsin outpatients with major depressive disorder and bipolar disorder. Canadian Journal of Psychiatry, 55(9), 568-576.
24. Price, A., Hilbrecht, M., & Billi,R. (2021). Chartinga path towards a public health approach for gambling harm prevention. Journal of Public Health,1–17. https://doi.org/10.1007/s10389- 020-01437-2
25. Yao, Y. H. C., & Potenza, M. N. (2015). Gambling disorder and other behavioral addictions: Recognition and treatment. Harvard Review of Psychiatry, 23(2), 134. https://doi.org/10.1097/HRP.0000000000000051
26. Rash, C. J., Weinstock, J., & Van Patten, R. (2016). A review of gambling disorder and substance use disorders. Substance abuse and rehabilitation, 7, 3.
interviewing or motivational enhancement)
integrating gambling screening and
26
IMPACTS OF PROBLEM GAMBLING ON MENTAL HEALTH
1. Sundqvist, K. & Rosendahl, I. (2019). Problem gambling and psychiatric comorbidity - risk and temporal sequencing among women and men: Results form the Swelogs case-controlstudy. Journal of Gambling Studies, 35, 757-771.27. Black, D. W., Allen, J., Bormann, N. L. (2021). Are comorbid disorders associated with changes in gambling activity? A longitudinal study of younger and older subjects with DSM-IV pathological gambling. Journal of Gambling Studies.
.
engaged in gambling.27
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